"Premature" urge to push

Archived User

"Premature" urge to push

May 12, 2010 12:53 PM

I've been hearing contradictory stories lately about the idea of
the "premature" urge to push during childbirth, and I'm hoping that
you can point me to some actual evidence on the topic. I've heard
lots of anecdotal stories, but I'd love to see research.

We've all heard that pushing on a cervix that's not dilated to
10 cm is a Really Bad Thing and can cause the cervix to tear or to
swell so badly that the baby can't emerge, necessitating a
C-section. But is that evidence-based? I've been talking to a lot
of women who started feeling pushy before 10 cm, often at about 7
or 8. Those who pushed as their body directed seemed to have good
outcomes, with no swelling or tearing. Those who were directed by
their midwife or OB to not push, and who resisted the pushing urge
or had the cervical lip pushed back, went through a lot of pain and
often had swelling. For many of them, being told not to push was
the first intervention in the classic snowball, and some wound up
with epidurals or even C-sections.

I've also read a couple of articles written by a midwife that
suggest, based on their own experiences, that if a woman pushes as
her body directs, even if she's not fully dilated she should be
okay.

http://www.midwiferytoday.com/articles/pushing.asp: "It has
become the paranoia of North American midwifery that someone will
push on an undilated cervix. Relax, this is not a big deal."

and

http://www.midwiferytoday.com/articles/RuleOf10.asp: "Could
professionals be mistaken about when women can begin bearing down
during labor, because they forgot one simple part of the
equation—that of observing non-medicated women in labor in
their natural habitats?"

It almost seems like telling women to resist the pushing urge
before 10 cm dilation, or manually pushing back the cervical lip,
is one of the few interventions that most midwives accept, even
though it might not actually be evidence based, and may be a relic
of 1960s-era births.

For a topic [early pushing] where there is such engrained custom
and practice, one would expect there to be a substantial research
base. Not only has it not been researched, but . . . little has
been written about it. . . . Early bearing down has spawned
practices based at best on worst-case-scenario thinking and at
worst on myth.

In my past, admittedly limited, experience as a doula in
cases where a client had an urge to push before full
dilation, women who were not fully dilated but were feeling
"pushy" did not bear down vigorously when left to their own devices
because, duh, it hurt. They mostly grunted a bit or gave
little, short pushes that were not much more than catches in their
breathing. And if you think about it, somehow as a species we
managed to birth our babies when we didn't have people doing
repeated vaginal exams and telling us what we could or couldn't do
in response to our internal urges. I think if a woman with a
premature urge to push has been upright, it makes sense to
recommend side-lying or all fours to get gravity out of the picture
and help relieve the downward pressure that may be triggering
a premature urge. Beyond that, I, like the sources you and I
have quoted, am not aware of any evidence that telling a woman to
resist the urge has any benefits, and it sure can make her
frantically distressed.